Knowledge translation — and its affiliated terms knowledge exchange, knowledge integration and knowledge mobilization — was coined to describe a process of taking what is known into what is done in health across the spectrum of science, practice, policy and the public’s health. As health issues become more complex due to the intertwining of demographics, technology, science, and cultural transformations the need to better understand evidence and its impact on health has never been higher. Questions remain: has demand met supply? How are the health professions dealing with this equation?
The Canadian Institutes of Health Research (CIHR), one of the earliest champions of the concept of knowledge translation in research, define it as:
a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically-sound application of knowledge to improve the health of Canadians (sic), provide more effective health services and products and strengthen the health care system.
These ideas are expanded below:
Synthesis – Synthesis, in this context, means the contextualization and integration of research findings of individual research studies within the larger body of knowledge on the topic. A synthesis must be reproducible and transparent in its methods, using quantitative and/or qualitative methods. It could take the form of a systematic review, follow the methods developed by the Cochrane Collaboration, result from a consensus conference or expert panel or synthesize qualitative or quantitative results. Realist syntheses, narrative syntheses, meta-analyses, meta-syntheses and practice guidelines are all forms of synthesis. Resources related to synthesis are available.
Dissemination – Dissemination involves identifying the appropriate audience and tailoring the message and medium to the audience. Dissemination activities can include such things as summaries for / briefings to stakeholders, educational sessions with patients, practitioners and/or policy makers, engaging knowledge users in developing and executing dissemination/implementation plan, tools creation, and media engagement.
Exchange – The exchange of knowledge refers to the interaction between the knowledge user and the researcher, resulting in mutual learning. According to the Canadian Health Services Research Foundation (CHSRF), the definition of knowledge exchange is “collaborative problem-solving between researchers and decision makers that happens through linkage and exchange. Effective knowledge exchange involves interaction between knowledge users and researchers and results in mutual learning through the process of planning, producing, disseminating, and applying existing or new research in decision-making.”
Ethically-sound application of knowledge – Ethically-sound KT activities for improved health are those that are consistent with ethical principles and norms, social values, as well as legal and other regulatory frameworks – while keeping in mind that principles, values and laws can compete among and between each other at any given point in time. The term application is used to refer to the iterative process by which knowledge is put into practice.
In short, knowledge translation is about taking what we learn and know from evidence, sharing that knowledge with others and assisting them to make useful health choices in practice and policy through KT.
This often involves communicating across contexts, disciplines, and roles between and from scientists, clinicians, policy makers and to the public alike. In a health environment that is increasingly becoming complex, the ability to communicate across boundaries is no longer an advantage, it’s an essential skill. While we may not always have the right language, we can translate meaning through stories.
But if stories are to be effective they need to be valued.
The value of storytelling
I’ve seen health professionals — scientists and clinicians — roll their eyes when you mention storytelling in a work context. It is as if the only legitimate role for stories is to communicate with children (which University of Alberta researchers are exploring as a tool for sharing health knowledge with parents). Yet, it is through stories that most people share what they know in every other context; why would it be different in health?
Perhaps it is the connotation that stories are ‘made up’ like children’s bedtime tales, but one need only look to journalism to find that we’ve been making ‘stories’ a central part of our life every day. We listen to drive-time radio for stories about the traffic conditions, we watch, download and listen to news stories filed by professional journalists and citizen bloggers alike on mainstream media, Twitter, YouTube, Facebook along with myriad sources across the web. Last week we were glued to various sources to learn stories — some of them false — and create stories about the events of the Boston Marathon bombings.
Stories are what conveys multiple information threads and puts it in a coherent context.
Stories are coherence engines.
Valuing knowledge translation
If knowledge translation is important then it should be reflected in research priorities and evidence for its impact on the system across different disciplines. Dr Shannon Scott and her U of A team recently conducted a systematic review of knowledge translation strategies in the allied health professions and found that the field was full of low quality studies that made it impossible to make firm statements on which methods were best among them . That team has recently proposed a systematic review looking at how the arts and visual methods can further contribute to KT in practice, although it likely the same issue with methodological quality might come into play here, too.
What she and her team are doing is looking at the process of sharing stories and, from a research perspective, sharing stories appears to not have been worth investing in scientifically. At least, not enough to generate a lot of studies and good evidence.
One could argue that knowledge translation is still new and that it takes time to generate such evidence. That is partly true, but it is also an easy prop for those who want to avoid the messiness that comes with communication (and its problematic research context), learning from others, and creating more equitable information spaces, which is what knowledge translation ultimately does. Knowledge translation has also been in use for almost 20 years so in that time — even with the most dismal assessment of the length of time it takes to put knowledge into practice — we should be seeing some decent research published.
KT is fundamentally about sharing. Journalists’ are rewarded for sharing — the more they share and the more people who they share with (as measured by readers, listeners, viewers etc..) the more successful they are in their work. Teachers are rewarded for sharing because that means that they are teaching people. Librarians are rewarded for sharing because that means people are checking out books and using the resources in their library.
We don’t apply the same standard to academic research, even though we have some crude metrics to measure reach and impact, and there is roughly no metric for the degree to which clinicians share among themselves. Maybe this needs to change.
I have scientific colleagues who are fierce in the face of their most strident academic critics and have delivered keynotes to auditoriums filled with researchers that are nearly paralyzed in the face of speaking to the public. This is not fear of public speaking, its fear of speaking to the public.
Should they be? I don’t think speaking to the public should be expected to be enjoyable for everyone, but neither are doing statistical calculations, completing ethics applications, or presenting posters at conferences, but we still expect scientists to do that. We still expect nurses, doctors, psychologists, medical technicians and social workers to traverse complex social problems to talk to their patients in an open and honest way.
Why is it when scientists are speaking to policy makers, clinicians to scientists, policy makers to the public, or any professional to another from another discipline, speciality or division we decide its not critical for them to make the effort?
Why don’t we do the research to support it?
Why is it OK not to do KT because its uncomfortable, awkward, difficult or confusing?
Declining interest, rising demand
It is perhaps for reasons like this that knowledge translation is so poorly understood and taken up as a focus for research. Looking at Google NGram data (which tracks mention of specific topics in books and publications) we see a steady rise in citations until about 2003 followed by a levelling off. Keep in mind that the leveling begins before social media became known. In the years after Twitter, Facebook and YouTube — arguably the most powerful communications media we have for doing knowledge translation widely (but perhaps not deeply) — there is roughly no sharp increase.
Below are the citations for the terms knowledge translation, knowledge exchange, and knowledge integration from 1996 (when the Web first started gaining wide use beyond academia and the military) and 2008, the latest year for which there is available data. Note that the numbers reflect general mentions as a percentage of overall terms, so they are relative, not absolute values.
Figure 1: Google NGram Data for KT, KE & KI: 1996-2008
Is there so much other stuff to talk about in 2013 that the relative importance of knowledge translation is diminished?
A look at Google Trend data using the same terms finds that not only are these concepts not growing, their mention is actually shrinking.
Looking at the three terms we see that all three concepts have declined over time. During these years — 2004-2013 — we saw not only the birth of social media, but the rise of Internet-enabled handheld devices to allow knowledge to be shared anywhere there is a data signal. We now have apps and nearly all of the Internets resources in our pockets and we are seeing a decline in the use of these terms.
Figure 2: Google Trend Data for KT, KE & KI: 1996-2013
So to review: We have a body of evidence in KT that is problematic and incomplete at the same time we have a decrease in use of the terms, while at the very same time we have a sharp rise in available tools and technologies to share information quickly and a continued, steady demand for more information to make decisions for health providers, patients, policy makers and insurers.
Yes, the data presented here are not perfect. But does it not make sense that there should at least be some trend upward if knowledge translation is valued? Should we not see some shift to more research, better research evidence, and greater interest given the tools and scope of communications we have through social media?
This begs the question: is knowledge translation in health too important to leave to health professionals?
In future posts this question will be looked at in greater depth. Stay tuned.
* Blog has been updated since original post
Not long after the Boston Marathon bombings occurred on Monday afternoon, several Twitter users noted that these kinds of real-time news events illustrate how incredible the service is as a source of breaking news, but at the same time how terrible it is.
Sure enough, there were plenty of fake news reports to go around on Monday, from reports of suspicious vehicles to the arrest of alleged perpetrators -- just as there were during superstorm Sandy…
If a health scare manifested itself in the world and there were no journalists to cover the story, what would the impact on the public be?
That is a question that lingered with me throughout the start of the 2013 Ontario Public Health Convention (TOPHC) which began with a morning dedicated to improving public health communication. Opening up the conference was a series of linked keynote presentations from a risk communications researcher (Julie Leask); a former newspaper editor, journalism professor and social media advocate (Wayne MacPhail), and one of Canada’s leading health specialist reporters (Helen Branswell).
The Academic’s Perspective
Keynote speaker Julie Leask (pictured above) and her colleague Dr. Claire Hooker (a good friend of mine) have been looking at the ways journalists engage in risk communication with the public on matters of public health from immunization to SARS to understanding the health priorities of professionals. In 2010 they published a paper looking at how the media covers health topics and argued that the health professions need to be aware of how stories are made, communicated and to be an active partner with reporters if they are to have positive impact in moments of health scares.
“It’s too late when the crisis comes up” – Julie Leask speaking on the need for public health to get engaged with the public using social media
In a previous post I wrote about how journalism is the fourth estate of medicine and public health. Journalists are the storytellers that the public listen to and are charged with looking at a problem from many perspectives to develop that coherent narrative that speaks to their audience. These are qualities that most scientists and public health professionals don’t bring to their jobs, nor are they always expected to or even should. As such, journalists play an important role for this very reason.
Nonetheless, the health sector has an uneasy relationship with journalism. Health professionals – particularly researchers — poorly understand the world of journalists and sometimes view the profession with suspicion. Julie Leask and her colleagues have found this to be the case, but argue that it is no reason to shy away from engaging the public using the tools that are comfortable to journalists. She spoke to the invaluable role of specialist health journalists in acting not only as producers of high quality health content in the news, but also guardians against low quality content making into press. In speaking to her research, she pointed out that specialist health journalists help educate their peers and editors on health issues, which are often complex and require more than a passing understanding of context to communicate well, as key gatekeepers for quality in the health landscape.
The Editor’s Perspective
To this end, Wayne MacPhail, a former editor of the Hamilton Spectator, argued that public health has a near ethical imperative (my choice of term) to be in the social media space to not only promote good health, but counter and challenge myths and misinformation. This isn’t some naive pronouncement that we’ll eliminate the snake oil sales or quackery that proliferates in the public sphere and media, but rather a simple observation that we have no chance of making impact if we are not even engaged in the space at all.
Like Leask, MacPhail says that it’s too late to engage the public when a health crisis comes up and that public health needs to be in the conversation stream before that happens.
The Reporter’s Perspective
Helen Branswell, a reporter from The Canadian Press, rounded out the panel and spoke frankly about the dwindling resources and rapidly changing landscape in journalism. She was on the front lines of reporting the 2003 SARS outbreak and showed a picture taken during that time of an empty newsroom and remarked how that the scene is the same now only for different reasons (limited budgets due to decreased ad revenue and the related shift to digital information on the web being two such reasons, among others).
Branswell paints a bleak picture of the present and future in many areas of health journalism. Stories are increasingly being covered by general reporters who may treat the story the same as they would a traffic incident, political story, or crime; journalists who are unlikely to know the context and details that are critical to communicating the nuances present in health matters. Interns are replacing some full time or veteran reporters in the newsroom and there are only a handful of specialists in practice.
Pressures from time, budget and competing interests in the newsroom are all contributing to an environment where quality health reporting is threatened.
I asked the panel what they thought public health should do to ensure that the healthy stories are reported well and there was little answers. Helen Branswell said, truthfully and somewhat cheekily: “buy newspapers”. She reminded us that we should be paying for the quality content and supporting good journalism in practice if we want it to survive, which is hard to argue against.
But that alone will not do all the work needed to preserve good journalism. I spoke to another conference attendee, a formally trained journalist who is now working with a research firm, about the ways in which journalists have helped other organizations craft their messages and engaging the public citing the Calgary Police Service’s social media team as an example. This pointed to ways in which journalists can make a difference in matters of public health and social services.
Yet, what about investigative journalism? What about the potential conflicts that come from being paid to report on issues that might be critical of the organization who does the paying (e.g., Ministries of Health, Departments of Public Health, Universities and colleges etc..)? This model doesn’t solve that, but it is at least another option.
Yet, the examples from public health taking this challenge of working with journalists up are few. Many still believe that social media is another means of broadcasting, which misses the mark. Others still view social media, journalism, engaging with the public through the media, with suspicion on the grounds that much of the work out there is not evidence based.
But what evidence did we have when SARS hit us 10 years ago? We had lots of epidemiological data on infectious disease, but that was only part of the story. Many of the leading health scientists were adapting their models, creating new ones and only after the disease left did we really have a full sense of what happened. We learned as we went.
This is what social media is all about, too. The lessons from major health events — disasters, outbreaks, and pandemics — parallel social media. It is innovation space at its clearest and thus there is an imperative to view it as innovation space with the tools and lenses that best support movement within complex adaptive system. From a communications standpoint, social media and the tools of modern journalism (and the style of communication they employ) are one thing to consider. Developmental design and evaluation are also among these tools combined with systems thinking.
Linear thinking and action will not work in a complex system and as this panel pointed out, there is much reason to be concerned if we are not prepared to communicate and support those that communicate well in such times when — not if — they come back.
Ten years after SARS how better off are we? And if we are better, how are we communicating that to the public?
Journalists occupy an important, yet often unacknowledged, role in the health system by providing a dispassionate account of the system’s strengths, weaknesses, and opportunities to the public. It is through journalists that much of the research we scientists and practitioners produce gets communicated to the audiences likely to use them. This fourth estate is also a place where hard questions can be asked and answered, holding governments, business and the health system itself to account because journalists operate apart from this space, unlike scientists and clinicians. We are at risk of losing this and it’s time to consider what that means for our collective health and wellbeing.
The news business is going through a massive upheaval, part of a larger overall disruption in media. Many newspapers are reducing the size of their print offerings, publishing less frequently or ceasing operations altogether.
This reduction in the capacity and size of the fourth estate begs two simple questions: Who will hold health scientists, clinicians, pharmaceutical companies, health product manufacturers, and policy makers to account? and who will tell the stories of science, health and medicine in public?
While we have some activist academics doing great work on influencing broader audiences like policy makers, they are exceptions not the norm. Stanton Glantz, a major tobacco control champion from UCSF who taken to blogging as a means of communicating to professionals and the public directly, is one of these such people. But Stan is atypical and holds a tenured position at a major university, something he’s acknowledged protected him when pursuing issues of evidence withholding from the tobacco companies in the 1990′s and beyond. Many faculty (particularly younger ones) are not this secure and even fewer independently funded scientists are. Academia is changing and not in ways that favour security and stability, which has implications for the kind of stories that get told.
Journalists have traditionally relied on protection from their publisher or producer under the name of journalistic freedom (the fourth estate) as a key pillar of their profession. It’s hard to imagine the Watergate scandal coming to light had Bob Woodward, Carl Bernstein and the other reporters working for the Washington Post, Time Magazine and New York Times not had the resources, stability and support provided by their newspapers . But what happens when these resources are no longer available or there are no institutions to support journalists in serving as watchdogs to hold people or institutions to account for what they do and don’t do?
Are ‘Monkeys in Coats’ A Healthy Story?
It’s been suggested that the Internet will take care of this. Citizen journalists, armed with camera-laden handsets connected to social media will fill the news gap. For example, it was citizens, not journalists, who first captured the story of Darwin the monkey, dressed in a shearling coat, walking around an Ikea parking lot in Toronto that went viral on a global scale on December 10, 2012. This is great for those interested in simian fashions and retail adventures, but the reason it was captured was because the story was obvious and in the face (or at the ankles) of those who told it. (For those of you not familiar with Toronto, coat-wearing monkeys are not typically seen at shopping centres or anywhere around town for that matter.)
Health and medicine is not the same as monkeys wearing coats (no matter what kind of joke you want to make). There is nuance, debate and reason that requires sustained attention and focus that someone with an iPhone and Twitter account is less likely to convey. Reasoned arguments for citizen journalism’s potential suggest it can complement the work of traditional journalism, not replace it. Yet, is this belief in one form (citizen journalism) undermining support for the other (traditional journalism) and serving as a fix that ultimately fails? If free-and-easy content is available, how likely are publishers willing to pay for professional work? Particularly if the choice of stories of one group (e.g., monkeys in coats) are more likely to garner the kind of attention that drives advertising than that of another (e.g., health care financing). Only one of these stories will impact our collective health.
Why does this matter? Trained journalists are required to be good communicators to a broad audience, scientists are not. Clinicians are slightly better, but decades of research has shown it is still highly problematic across areas of practice. This will not be solved overnight, if at all. Scientists and clinicians have told me they are already burdened with enough job expectations and adding knowledge translation skills to that list is asking too much.
As I have argued previously, there is a valued place for synthetics in research: those are who are good at taking ideas and weaving them together into an accessible narrative. Journalists are ideally suited to play or support this role. They do the job that many scientists can’t or won’t do and have better to tools, skills and strategies to do it. They write in a style that is suited to broad audiences in a way that suit those audiences’ needs, not what funders, disciplinary traditions, universities, or scientific peers demand (without evidence that those methods of communication are effective). There are reasons why journalists assess the reach of their work in the thousands and social scientists in the dozens (by citations in their field of practice).
Going Deeper to See Clearer
Although we have more information about health available to us than ever before, this may not be healthy for patients. The potential for those uninformed about medical diagnostics, evidence, and the nature of health itself to make poor choices based on incomplete, incorrect or overwhelming information is high. Further, without the kind of dispassionate examination of evidence in a synthetic manner that is tied to the way in which that evidence is expressed in the world through public opinion, policy making and healthcare practices, we lose a major accountability mechanism and means of informing public discourse.
In October I co-delivered a workshop on health evidence for students at the University of Toronto with the 2012 Hancock Lecturer and journalist Julia Belluz. Julia writes the Science-ish blog for Macleans Magazine and is an Associate Editor with the Medical Post. Julia`s lecture was on the role that social media plays in our health system and how its power to leverage the attention of the masses — for good and ill — is shaping the public understanding of health and medicine often in the absence of evidence for effects of conditions, processes, and practice. The lecture is summarized online on Science-ish beginning here.
Reading through the lecture notes one sees a depth of study that would be unlikely to be found anywhere within the formal health system. The reasons are that it blends evidence with commentary, observation with carefully selected sources, and takes a perspective that seeks to inform a wide, not narrow audience in both practical and intellectually stimulating ways. Taken together, this is a collection of activities that are not within the scope of practice for scientists and practitioners. There are reasons why the greatest contributors to public discourse on many scientific issues has come from journalists, not the scientists who generate the research. They tell the story better.
Malcolm Gladwell, Steven Johnson, Mitch Waldrop, Julia Belluz, Andre Picard and others are a big part of the reasons most of the those who vote to support funding of science, who donate to research-related causes, and fight for policies to keep us healthy know of the research that backs those ideas up.
Imperfect as journalism is, it serves the public when done with integrity. It’s worth spending some time considering what can be done to support the fourth estate so it supports us.
Photo credit: DBduo Photography on Flickr used under Creative Commons Licence.
For the past few days, I have been thinking about the evolution of what media is and its expanded role in the information ecosystem. What got me thinking was Twitter co-founder and Square CEO Jack Dorsey's decision to blog his side of the story about his reduced role at Twitter. A few months ago, when Facebook was buying Instagram, …
When Karl Marx asked: Who owns the presses? he was referring to the ability of wealthy private individuals to control the means of knowledge production and dissemination and thus, influence society as capital owners, not as citizens. The unequal voice of the bourgeoisie over the proletariat was what gave them undue social power. But what happens when the owners and generators of wealth (knowledge, information) shift and the result is a community that relies on the medium of production without the control of it?
Owning the presses
Social media presents something quite unusual when it comes to the traditional views of ownership and wealth creation. It also upends the traditional perspectives of journalism and marketing, where the content is co-created and edited, emergent and distributed through a mesh of networks, uncontrolled. It is a new space for which traditional models of ownership, rights, responsibilities, and governance are all joined up in something that is similar enough to have familiarity, yet different enough to be alien at the same time. It’s not a wicked problem, but it does contain some problem wickedness.
With social media, the messages are that of the users, arguably creating the most democratic (or at least free) environments for communication. Although hosts such as Facebook, Google, and Twitter have occasionally squelched certain users’ voices for reasons of legality, politics or questionable fit with their “community values”, most of what happens on these platforms is up to its users. That is what makes social media as powerful as it is. Social media is nothing without its users’ content.
My definition of social media is:
Social media is any networked electronic media that derives its principal value from user participation
Yet, this does not render Marx’s question about press ownership irrelevant when updated to today, rather it changes the answer.
It’s paradoxical in that the very market forces of competition that can seed innovation and the mechanisms provided by venture capital and capitalist investment is the reason we have the social media platforms we do, yet the manner in which it is governed is much like that of socialism at best, communism at worst. Investment of private financial capital has helped raise the profile and capability of social media companies to leverage social capital. It is why open source, community-owned or shared tools like Diaspora* or Identi.ca have come nowhere close to replacing Facebook and Twitter respectively. The free market creates the tools, yet it is not the free market that sustains the community created by those tools, nor can it fully account for how to grow the capability of those tools.
It is also because these companies operate within markets rather than as national projects, that they can disseminate globally with relative ease. Thanks to this dissemination, citizens living in oppressive media environments can reach out and connect with those outside of such spaces allowing things like the Arab Spring and increased freedoms in Myanmar to emerge with greater outside support than had these tools not been available.
The cost of free
While social media has done much to enhance democracy movements, human rights watches, and access to information, there is a slight problem . The most widespread social networks are all free to use, which means that they need to generate revenue from sources other than user fees, which usually means advertising. And advertising means clutter, clutter leads to confusion and that turns people away (witness the loss of viewership from TV at a time when perhaps the highest quality productions are being aired ). But unlike television, there is a social cost to free with social media. Human capital in the order of millions of hours of time and a similar amount in dollars is spent creating the very content that allows social media to survive and thrive.
With the relaunching of MySpace we are reminded of how far social media platforms can go up and down. Just a few years ago, MySpace was the darling of social media with millions of users and lots of press. Hundreds of thousands of hours of individuals’ time went into making and maintaining MySpace pages, resources that are now, ironically (given Justin Timberlake’s involvement in the platform) Dead and Gone.
It can be argued that similar deep investments of time in building and maintaining Facebook pages, timelines, and Tweet projects exist. What if these go away?
Or what if they become unusable? Anyone who has spent time on Facebook (which is a few hundred million people strong) has seen the steady creep of unsolicited content emerging in their news feed. This includes notices about pages you may like, game invitations, increased posts from companies or services you chose to “like” and more. Facebook needs revenue to justify its initial valuation and a big focus now is on the mobile experience where an increasing amount of its traffic is now generated from. The problem is that mobile ads are even more distracting than those on other systems because of the smaller screen size and different interface. It is difficult enough to surf the content on a laptop, let alone a handheld device. If you think your desktop version of Facebook is cluttered, imagine what the mobile version of that could look like?
Facebook is rapidly becoming a ‘necessary evil’ for me and others like me. I have few other means of communicating with certain people other than Facebook. This should be a good thing for Mark Zuckerberg and company, right? Maybe not. For some, there is little joy in using Facebook anymore as it gets swarmed with messages and the endless quest for likes and attention from those who are not even your friends. The result is that more people in my circles are reducing their use of Facebook or breaking from it altogether largely because it holds far less esteem than other brands such as Apple or Google. There is a brand cost to Facebook’s decisions.
The brand is not the only thing that costs; there are hidden social costs as well. Among those vying for likes and attention are charities, non-profit, health and social service groups who have opted to spend precious resources on building up profiles on social media, curating content and relying on platforms like Facebook and Twitter for building their brand, relationships or using it as part of their internal and external communications. They are doing this because that is where the most people are and they feel the pressure to go where those numbers are, even if they are fickle (see MySpace).
Should we care?
The business model of social
One answer is: it doesn’t matter. Social media companies are businesses and it is their prerogative to make money. However, there are real social costs associated with this drive for profit in the social mediasphere. If people start fleeing Facebook or can’t manage Twitter because of restrictions or choices made based on that company’s market optimization plan (e.g., advertising, relaxed privacy etc..), then the social capital created through those services decreases, requiring the increase in new social and financial capital to support something else. For those that sought to dive into social media this means retraining staff, retooling media platforms, redesigning messages, and in some cases rebranding entirely to suit the next big thing. This costs real money.
While it is bad enough that individuals lose their social investment, this has bigger implications for health care and protection providers, charitable organizations, social service groups and alike others who all rely partly on social media for communications and relationship development. A recent paper in the Journal of Medical Internet Research looked at the factors influencing social media adoption among physicians. In that study 58% of physicians surveyed said that social media enabled them to look after patients more effectively, and 60% said it improved the quality of the patient encounter. It has taken a long time to get health care professionals on board, but the stability and relative ubiquity of platforms like YouTube, Facebook, and Twitter have made investment in social media a safer bet.
Sure, media changes and evolves, but what we are seeing with social media today (particularly the largest players) is something never seen before. There is a global scale that has fundamentally altered the communications landscape. Facebook and Twitter are not just tools, they are platforms not unlike email and that makes them different.
Virtually every successful social media platform has started out as free, uncluttered and focused on building a user base. And every one of those faces the question: what is the business model? Advertising will only go so far and the efforts to engage in ‘promoted’ anything (tweets, videos etc..) can run the risk of turning a medium based on authenticity into something much less so.
What alternatives? More questions.
We face a situation where the very entrepreneurial spirit and funding through capitalism has produced a somewhat self-governed media system run by workers who produce the knowledge, which is like socialism. All ‘ism’s’ aside for the moment, there is benefit to having conversations about the ownership and control of the social media presses in an era where the media is more than just the messages and now integral to many of the operations and livelihoods of organizations and individuals who do not work for social media. There is a disjuncture between ownership, the means of production, the workers, and the product that doesn’t fit any previous model posed by Marx, Adam Smith or anyone.
Unlike the coal miner and their families that lose when the mine shuts down, there is some foresight available to them knowing that they are in a particular industry. For social media users, their communications are just part of their life not a part of their industry.Put another way, consider email. Right now, if your email service is failing you or fails as a business you have the ability to get a new one without disrupting your experience of and access to the medium itself. Gmail, Yahoo! or any corporate mailserver will generally produce the same thing even if the interface and management of that experience varies. We don’t have real alternative to Facebook or Twitter right now. When over a billion people use these services it is time to ask: should we? Can we? Is that a good idea?
Is social media getting to be an ‘essential service’?
Does social media belong in the commons? If so, will that inhibit the necessary innovation sparks that led to the development of the current tools in the first place? Who would manage it?
If these went away, what would replace it? Or will we see a bubble and lose so much trust in a collapse that these tools fail to regain interest?
Should we pay for social media in exchange for better usability and less clutter? Will anyone who had it for free do this? And who is left out of those social worlds if they can’t pay? Right now social media’s great asset is that anyone can join and join to anyone else who allows it. Nationalism, politics, financial means, sex, race, gender all don’t matter in terms of fundamental access, but that could change.
Would my Twittersphere be less if only people like me were on it? What kinds of conversations wouldn’t take place?
If we all provide the content and labour, should we have a say in who owns (or runs) the presses in a world of social media?
What would Marx and Adam Smith think of all of this? Maybe if they were here today they could Tweet a debate on it.
Social media is any networked information technology, tool or platform that derives its content and principal value from user engagement and permits those users to interact with that content. But last time I checked (in), the content stream being produced through my media stream was becoming a lot less social (Web 2.0) and more of a throwback to the media of old (Web 1.0); the implications could be considerable for those wishing to reach new audiences or create them in the first place.
It’s been a rough ride for social media companies. On Friday Facebook’s shares were at a record low since their IPO a couple months ago. Last month, Twitter provoked much concern after dropping its partnership with LinkedIn as part of its desire to have greater control over its messaging, prompting concern that Twitter might end up closing itself off to 3rd party applications like EchoFon, HootSuite and Tweetbot to ensure quality. This desire for tailoring and control of messages and trends has prompted some to suggest that Twitter may be ruining itself in the process.
The issue is not just one of control, but of a disrespect for the complexity and conversation that makes social media attractive to its users. In short: it’s about the social, not the media.
Social media, non social content
Scanning through my Facebook page its easy to see why their stock is dropping and will continue to do so. In their quest to justify their valuation, Facebook needs to find ways to make money from what people post and pictures of people’s kids, quips about daily hassles and joys, sharing cat videos, and posting check-ins at a local restaurant aren’t enough to justify a $100bn valuation. To do this, they need advertising dollars and deals with game makers and app developers to drive revenue up. Aside from the possibility of games, there is little social about advertising, no matter what kind of spin is offered.
Within a year my Facebook page has gone from a loose collection of social miscellany from friends and family to a steady stream of non-social junk with advertisements in the form of page updates, news stories that require me to accept an app that sends me more ads, and a litany of non-essential information.
The signal to noise ratio has officially flipped from more noise and less signal.
Bit by bit, Facebook is choking its users to death with ephemera and it would not surprise me if in two years we refer to it as we do MySpace today. YouTube is also running perilously close to offering too much media with not enough message as users increasingly have to sit through advertisements or click on banner ads before accessing content. News sites like the Globe and Mail will run a 30 second advertisement before allowing you to see a 20 second news clip, a 150% advertisement to content ratio on some stories.
I remember a few years ago when my email took the same turn. Now, probably 75 per cent of my received (non-spam!) email goes unread and is immediately deleted on sight. This isn’t necessarily spam, much of it is bacn, the kind of updates that I might have subscribed to voluntarily or I receive as part of a professional membership or affiliation. However, it’s severely disabled email’s potential and is now a ‘necessary evil’ instead of a useful tool I welcomed having in my toolkit.
Speaking to colleagues, it is not unreasonable to hear of people receiving messages in the hundreds each day and spending more than 3 hours per day just managing that content alone. How is this helping us communicate better? To learn?
This is one gigantic distraction and is not proving useful to improving our communications or helping us integrate the knowledge we receive and already have. Some claim that the era of big data will allow advertisers to target their ads with such exceptional focus and appropriateness that they will be serving us as much as we are needed to service them. I somehow doubt that.
From Web 2.0 back to 1.0
Consider the definition of what social media is on Wikipedia (as Web 2.0):
Web 2.0 is a concept that takes the network as a platform for information sharing, interoperability, user-centered design, and collaboration on the World Wide Web. A Web 2.0 site allows users to interact and collaborate with each other in a social media dialogue as creators (prosumers) of user-generated content in a virtual community, in contrast to websites where users (consumers) are limited to the passive viewing of content that was created for them. Examples of Web 2.0 include social networking sites, blogs, wikis, video sharing sites, hosted services, web applications, mashups and folksonomies.
When my social media stream is filled with promoted tweets, sponsored posts, ‘like’ requests on advertisements or updates from projects, I lose the social and just end up with media.
Social media is at its best when it is a conversation. Sometimes the conversation involves a lot of talking on one side, but there is a genuine back-and-forth, an unpredictability to it, and a non-linear dynamic that makes it interesting. Straight-to-viewer messages that offer no ways to engage except to watch, click off or ‘like’ don’t make for a conversation.
Imposing Structure and Losing Complexity
In trying to turn a setting where complexity, emergence and non-linearity come alive and work to create conversation, social media property managers are stifling the very thing that makes their tools and platforms so attractive. Creativity is born from serendipity and diverse connections. In imposing structures that remove or highly limit this potential for discovery by adding unnecessary noise, we are a risk of losing some of the best tools for idea testing, discussion, and knowledge translation we have ever known by reducing the opportunities for serendipity.
It is the commercial drive that contributed to bringing these tools in the first place, however that drive can lead to blindness creating an Internet ivory tower rather than a true marketplace of ideas as advocated in the Cluetrain Manifesto, which looked at how markets operate as innovation hubs by promoting conversations.
From markets to artists, the messages that are created by media are related to the media itself. Marshall McLuhan knew that and so did his peer, Edmund Snow Carpenter. Mathematician-artist a Youtube video maker vihart knows this too and spoke to Carpenter’s thesis in a terrific short video below.
In critiquing the push for standard ‘best practices’ in social media, vihart (and Carpenter, by posthumous extension) point to the ways in which the traditional media formats that advertisers desperately wish to use to contain your attention (and limit your feedback) is exactly the opposite of the new media.
Taken from the forward of Carpenter’s book, They Became What They Beheld, (and explicated beautifully by vihart) come some rules of communication commonly pursued by traditionalists and reasons why we shouldn’t pay attention. These rules as noted by Carpenter are:
1. Know your audience and address yourself directly to it
2. Know what you want to say and say it clearly and fully
3. Reach the maximum audience by using existing channels
Whatever sense this may have made in world of print, it makes no sense today. In fact, the reverse of each rule applies.
If you address yourself to an audience, you accept at the outset the basic premises that unite the audience. You put on the audience, repeating cliches familiar to it. But artists don’t address themselves to audiences; they create audiences. The artist talks to himself out lout. If what he has to say is significant, others hear & are affected.
The trouble with knowing what to say and saying it clearly and fully, is that clear speaking is generally obsolete thinking. Clear statement is like an art object: it is the afterlife of the process which called it into being. The process itself is the significant step and, especially at the beginning, is often incomplete and uncertain.
The problem with full statement is that it doesn’t involve: it leaves no room for participation; it’s address to consumer, not co-producer.
One is left watching this video with the question: what happens when social media has too much media, not enough message?
In this second post on marketing complexity I look at how the allure of simple and easy lulls us into seeing past complexity and focusing on the least powerful forces that impact sustained change and meaningful innovation.
H.L. Mencken’s oft quoted phrase (including on this blog) about simple answers being wrong lest we commit to doing the wrong things righter (as Russell Ackoff said) . Simplicity however, is seductive,”neat”, “clean” and wrong when it comes to addressing complex problems. Such problems require complex responses and such responses are hard to market to a public used to the neat and clean. To take a look at how this happens it’s first worth contemplating ways we get people to buy into the simple, wrong ideas in the first place.
Going past the guru
We’ve all seen the gurus and maybe have a few of their books on our shelves. They can make us feel good as they feel our pain and propose 3, 5, 7, 10, 101 simple, easy steps to success. Lists are everywhere packed with gems toting advice on how we can be better, live better, perform better and beyond. The track record of success for these books is mixed in their impact on human action, but they might make people feel better about themselves. Mitch Joel over at Six Pixels of Separation / Twist Image even noted how this desire for inspiration in simple motivational messagin has found its way increasingly into the world of Facebook.
“If you cannot find peace within yourself, you will never find it anywhere else.” - Marvin Gaye. I just saw an image on Facebook of this quote. It’s not the first time. Over the past couple of weeks, I’ve noticed a veritable onslaught of motivation and personal development quotes that are embedded in images (with varying degrees of artistic quality). Some of them are profound and powerful and some of them are quirky and cheesy. My added interest in this trend is the request to share, comment and spread them.
They are everywhere and I’ve shared some of them on Facebook and Twitter, too. But the sheer volume of these messages ironically might be their undoing in effect. It is as if the world is fine and we’re OK and life really is simple at its core. This, like many profundities in this world, is both the truth and a lie. Being true to yourself and aware is incredibly powerful, but it alone doesn’t change our collective wellbeing unless most of us do it together. For that, we need to do the work outside ourselves and within simultaneously. These messages imply change is simple (and sometimes easy), but the mistake is in thinking changing your world is changing the world at the same time.
Aspiring for change and doing the work to get it
This is both a marketing and unmarketing problem. Simple sells. It’s easy to Tweet and relatively simple to package. It’s also easy to mislead people into a sense of false progress and inspiring guruship with those who are the prophets or thought leaders behind this simplistic thinking. The next step is taking the meaning in these messages of hope and inspiration and connecting them to something beyond ourselves into something larger. It also means wishing for better, thinking healthier and acting on these in the world requires work. A lot of work… and that is unsexy and complicated.
Seth Godin is one who I find to be an ‘unsexy’ (with apologies to Seth, this is about his ideas not him) truth-telling antidote to the guru. His messages about success are both inspirational and aspirational, but always gilded with a message that the path is complex: it is about discovering our art, committing to it, sharing it with the world, and keeping at it over the bumps (work hard) while knowing when or if to quit.
In an age where there is a quick fix, discovering one’s art no matter what it is and living life through it not something that has a recipe attached to it. It requires we pay attention to ourselves (and our world) and our deepest needs, but also the patterns forming around us. Yet, with so much information swirling around us, we run into a problem of a widening signal to noise ratio. In marketing every message we send has to get through the din created by all the other marketing messages on every medium or device, all the other correspondence, the social media channels, the billboards, the books and pamphlets and on-the-field paint that bombards us with signals that are largely about creating an image of cause and effect.
Simple (but not obvious) rules
So how to get through it? One of the ways we naturally navigate through complexity is the use of heuristics (PDF book link). Heuristics are guidelines* that serve as simple rules to follow, providing a start point in the complex environment from which to act on. A tongue-in-cheek hueristic is to follow someone when in doubt, building on Douglas Adams’ line in The Hitchikers Guide to the Galaxy:
Follow that car, it looks like it knows where it’s going.
But this can fail us in complex environments and sometimes simple ones. Our preoccupation with leadership, success, and champions can be leading us on the wrong path. In a post earlier today, Annie Murphy Paul provoked some thinking about what it means to be #1 in a particular field and how it may be wiser to learn from #2 if we are seeking to emulate success in our work. Paul recognizes that success sometimes involves good fortune that cannot be planned, yet that there is research that suggests those not considered the guru might be worth paying attention to if we relax our gaze. She writes:
Tellingly, the most genuinely useful innovations tend to emerge from companies’ on-the-ground responses to economic and social challenges — not from business advice books. So concluded researchers Danny Miller and Jon Hartwick in an article in the Harvard Business Review, for which they tracked the coverage of business trends in academic, professional, business and trade publications over a 17-year period. Evanescent fads, they found, are usually simple, one-size-fits-all solutions promoted by charismatic “gurus.” Approaches with real staying power are more complex and multifaceted, and demand deep organizational changes.
Gurus, reputation and the failure of filters
One of the ways around this is to create filters based on reputation, which is at the core of social network research. However, it also falls into the trap mentioned by Murphy as attracting followers to the wrong gurus. Gurus can also be in the form of institutions. Another post by Mark Carrigan on the London School of Economics Impact of Social Sciences blog about how high impact journals also carry with them a sense of cultural power that off-loads much of the critical thinking to academic reputation. Drawing on the parallels with the art world, he points to the issue of time:
The obscenely wealthy but time-poor rely on such brands to guarantee the virtues of the art they invest in, assuaging the insecurities about their purchases which are only sustained because “they are not willing to spend the time required to educate themselves to the point of overcoming insecurity”.
We do this in scholarly work all the time and, I believe, even more so as the number of academic sources rise and our filters get filled. As I’ve discussed elsewhere, we are becoming overwhelmed by information and filter failure, short on time, and struggling to make sense of the complexity around us partly as a result of all of this. As complexity grows, the patterns of action become harder to see.
Carrigan challenges us to imagine what might happen if one of these patterns — prestige title — was removed:
Is it the case that within the academic world, inclusion in a prestigious journal becomes a substitute for, and certainly is a reinforcement of, intellectual judgement? As a thought-experiment: how would academic life differ if these status hierarchies weren’t available to help us navigate the knowledge system? How would we respond? I suspect that activities which are already everyday features of the academic world (particularly dialogue and debate within communities of practice) would take on a newfound importance. What else would be different?
For any marketing of complexity to work, the risk in creating a false guru is high, but so too is the risk of installing overly simplistic filters (reputation-heavy promotion). In both cases we need to address complexity with a complex response and doing so with one that doesn’t exacerbate the problem by adding too much extraneous information to our media ecology, getting us back into trouble elsewhere. This is pointing to problems, however there are possible ways to address them. In an upcoming post, I’ll explore what some of these are.
* I purposefully did not use the common term “rule of thumb” on account of its contested origin and overuse.